Lyme Disease and Depression: A Case of Treatment-Resistant Depression in a Teenager

Lyme disease and depression can be closely linked. Treatment-resistant depression in teenagers rarely prompts Lyme disease testing—even when accompanied by cognitive decline, academic failure, and a history of tick exposure.

Neuropsychiatric symptoms—including depression, anxiety, irritability, and cognitive impairment—are increasingly recognized manifestations of neurologic Lyme disease.

In this case, a 16-year-old boy with worsening depression developed suicidal thoughts, cognitive decline, and academic failure. His symptoms were initially attributed to laziness or mild depression.

After 12 weeks of intravenous antibiotic therapy, his depression resolved without antidepressants, his IQ improved by 22 points, and his academic performance markedly improved.

For a broader discussion of how Lyme disease can be overlooked in children, see Pediatric Lyme Disease: Why Children Are Often Misdiagnosed.

Depression as a Manifestation of Lyme Disease

Depression is increasingly recognized as one of the neuropsychiatric manifestations of Lyme disease. In some patients, mood changes may appear before more classic physical symptoms are recognized.

One study examining patients referred to the Lyme Center Apeldoorn in the Netherlands found a high prevalence of depression among individuals evaluated for Lyme disease between 2008 and 2014. Approximately one in five patients treated at the center carried diagnoses of both depression and Lyme disease.

Dr. Robert Bransfield, a psychiatrist specializing in tick-borne illness, has reported that depression may be the most common psychiatric syndrome associated with late-stage Lyme disease.

He has also estimated that Lyme disease and associated tick-borne illnesses may contribute to a significant number of suicides each year, highlighting the potential severity of untreated neuropsychiatric symptoms.

Neuropsychiatric symptoms are discussed more broadly in our overview of psychiatric Lyme disease.

A 16-Year-Old Boy Whose Depression Was Lyme Disease

Brian Fallon, MD, director of the Lyme and Tick-Borne Diseases Research Center at Columbia University, describes the case of a 16-year-old adolescent with long-standing depression that suddenly worsened.

The boy developed anger, frustration, insomnia, poor appetite, mild weight loss, and passive suicidal ideation. At times he would say, “I wish I could just die in my sleep.”

He also complained of brain fog and a steep decline in cognitive abilities. His symptoms were initially presumed to be caused by either laziness or mild depression.

He suffered from ongoing knee pain and was forced to quit sports. His grades dropped from A’s in seventh grade to nearly failing by tenth grade. Fatigue and forgetfulness worsened, and he struggled to get out of bed each morning.

Symptoms Beyond Depression

The boy’s symptoms extended well beyond depression. He experienced severe headaches, facial fasciculations, myalgias, stiff neck, hyperacusis, episodic paresthesias of the face and hands, sudden sweating, painful joints, sore throats, palpitations, and electric shock-like pains.

He also developed word-finding difficulty, semantic paraphasias, and severe short-term memory impairment that prevented him from recalling conversations.

Because he reported prior tick exposure, Lyme disease was considered clinically despite negative screening tests. His Lyme ELISA results were negative twice during the prior three months, but an IgG Western blot revealed four of the five CDC-specific bands.

A brain SPECT scan revealed abnormalities consistent with encephalitis, vasculitis, and Lyme disease.

Treatment Response and Recovery

The adolescent was diagnosed with probable Lyme encephalopathy and treated with 12 weeks of intravenous ceftriaxone.

Following treatment, his sleep, appetite, headaches, joint pains, numbness, distractibility, short-term memory, and emotional stability improved significantly.

Most notably, his depression resolved without antidepressant medication. His IQ increased by 22 points, and his academic performance markedly improved.

Clinical Takeaway

This case illustrates that Lyme disease presenting as depression in a teenager can be profoundly disabling—but also potentially reversible when the underlying infection is recognized and treated.

When depression occurs alongside cognitive decline, migratory pain, neurologic symptoms, and a history of tick exposure, clinicians should consider Lyme disease in the differential diagnosis even when screening tests such as ELISA are negative. Western blot testing and clinical evaluation may reveal infection that initial screening missed.

If you or someone you know is experiencing suicidal thoughts, contact the 988 Suicide & Crisis Lifeline: call or text 988 or visit 988lifeline.org.

Frequently Asked Questions

Can Lyme disease present as depression in teenagers?

Yes. Lyme encephalopathy can produce depression, cognitive decline, academic failure, and suicidal ideation that may initially resemble primary psychiatric illness.

Can Lyme disease affect IQ?

Yes. In this case, the patient’s IQ improved by 22 points after antibiotic treatment, suggesting that cognitive impairment from Lyme encephalopathy can be reversible.

Can Lyme ELISA be negative when Lyme disease is present?

Yes. In this case, ELISA testing was negative twice while the IgG Western blot was positive. A negative ELISA does not always rule out Lyme disease.

What is Lyme encephalopathy?

Lyme encephalopathy is a form of neurologic Lyme disease affecting the brain, producing cognitive impairment, mood changes, and neuropsychiatric symptoms. Brain imaging may reveal inflammatory changes.

Did the depression require antidepressant medication?

No. In this case, depression resolved entirely after treatment of the underlying Lyme infection.

Can Lyme disease cause psychiatric symptoms?

Yes. Lyme disease affecting the nervous system can produce neuropsychiatric symptoms including depression, anxiety, irritability, cognitive impairment, and sleep disturbance.